What is Soriatane? How does Soriatane(acitretin) help in the treatment of psoriasis? What research has been done on Soriatane?
Soritane, aromatic retinoid, comes in a gelatin pill form treatment for Psoriasis. The active ingredient in Soriatane is related to Vitamin A so you are warned about taking supplements. Bothwomen and indirectly men are warned about pregnancy for up to three years after taking Soriatane. There are also warnings as to alcohol intake. There are also warnings about possible depression, dry eyes and chapped lips.
The skin grows usually every 28 days or so whereas in psoriasis, it grows every three to six days and forms plaques or lesions.
. Psoriasis is often called an "immune-mediated" disorder where the immune system attacks itself. Close to five million people in the U.S. suffer from Psoriasis. Studies show there is a genetic component but as of yet don't know what triggers the outbreaks. Some say to avoid acidic food, alcohol, root vegetables and coffee but there is no firm research to back that up. Possible triggers for psoriasis are emotional stress, reactions to certain drugs such as lithium, ace inhibitors, and beta blockers. Changes in weather may be a trigger for psoriasis. Then there are skin trauma, and infection. .An indepth article can be found here
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If you place your order online at the above pharmacy and just fax in your prescription, you save on 9.95 handing and shipping charge. Soriatane is almost 1/3 of the cost at what you would pay at US pharmacies.
Curr Drug Targets Inflamm Allergy. 2004 Jun;3(2):199-204. : New vitamin d analogs in psoriasis.
Fogh K, Kragballe K.
Department of Dermatology, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark.
SEK12JNI@aas.auh.dk
Psoriasis is a common inflammatory and hyperproleferative skin disease characterized by infiltrated plaques of the skin and may involve nails, scalp and intertreginous areas. Recent years of research has shown that psoriasis can be treated topically with analogs of vitamin-D(3). Impaired differentiation and increased proliferation of epidermal keratinocytes are key features in psoriatic lesions together with a local activation of T lymphocytes. Evidence has accumulated that analogs of vitamin D(3) increase differentiation and inhibit proliferation of keratinocytes. Topical treatment with analogs of vitamin D(3) have in a number of trials shown improvement of psoriasis. Vitamin D analogs show the same efficacy as potent topical corticosteroids and do not produce skin atrophy during long-term therapy. Vitamin D analogs can be used both as monotherapy and in combination with topical corticosteroids, UVB, PUVA, acitretin, methotrexate and cyclosporine. The vitamin D(3) analog calcipotriol has been investigated in most detail and is available as an ointment, a cream and as a scalp solution. From clinical studies involving several thousands of patients, it can be concluded that calcipotriol is efficacious, safe and well-tolerated even on a long term basis
Curr Drug Targets Inflamm Allergy. 2004 Jun;3(2):145-56. : Established treatments of psoriasis.
Van De Kerkhof PC, Vissers WH.
Department of Dermatology, University Medical Centre St. Radboud, Nijmegen, The Netherlands.
p.vandekerkhof@derma.umcn.nl
Psoriasis is a complex disease with a spectrum of clinical manifestations. Psoriasis may express as a few coin-sized erythemato-squamous plaques up to widespread disease covering the entire body surface (erythrodermic psoriasis). Psoriasis may present as a few stable plaques or unstable disease, rapidly relapsing after treatment. Some patients may respond excellently to topical treatments whereas other patients may be difficult to manage, showing treatment resistance even to the systemic treatments. Therefore, a spectrum of treatments is available to individualize care of psoriasis. In this chapter the available treatments are presented. The vast majority of patients is treated with topical treatments, with vitamin D(3)analogs and topical corticosteroids as the first line treatments. Tazarotene is an alternative for vitamin D(3) treatment if this treatment fails. In some special cases, dithranol and tar treatment may be used. Phototherapy with UVB and photochemotherapy (PUVA) are indicated in patients not responding sufficiently to topical treatment. However, chronic exposure, in particular to photochemotherapy implies an increased risk for photo- carcinogenicity. Systemic treatments including methotrexate, cyclosporin, acitretin and fumarates are indicated in patients who cannot be managed with topical treatments or phototherapy, either for treatment resistance or cumulative toxicity. In this article the opportunities and limitations of the available treatments are presented.
: Br J Dermatol. 2004 Apr;150(4):741-6.: Fumaric acid esters in severe psoriasis, including experience of use in combination with other systemic modalities.
Balasubramaniam P, Stevenson O, Berth-Jones J.
George Eliot Hospital, Nuneaton CV10 7DJ and Walsgrave Hospital, Coventry CV2 2DX, UK.
BACKGROUND: Fumaric acid esters (FAE) are used as a systemic treatment for severe psoriasis in Germany but there has been only very little published experience from the U.K. The potential for use in combination with other systemic drugs has not been explored. OBJECTIVES: To present data relating to the efficacy of FAE in severe psoriasis and to examine the potential dose-sparing effect and safety issues when FAE are combined with other systemic agents. METHODS: We retrospectively analysed the records of patients who had received FAE for severe psoriasis either alone (in two cases) or along with other systemic medications (in 10 cases). We reviewed the efficacy of FAE and assessed whether dose reductions were achieved for other systemic drugs. Patients were monitored carefully for possible adverse effects. RESULTS: Of 12 patients treated with FAE one discontinued the drug very early, due to flushing, while on a very low dose. The other 11 patients all demonstrated an improvement in psoriasis after starting FAE. Nine patients received FAE in combination with other systemic therapies including ciclosporin, acitretin, hydroxyurea and methotrexate. Seven achieved useful overall reductions in the dose of the other drugs. In two patients severe psoriasis was controlled using FAE alone. The side-effect profile of FAE was similar to that previously reported. There was no evidence of drug interactions. CONCLUSIONS: FAE appear effective and less toxic than other systemic treatments for psoriasis. FAE were used successfully in combination with other systemic agents and generally enabled the doses of the more hazardous drugs to be reduced. Extremely careful monitoring is required when using FAE in such combined regimens as experience is currently very limited.
J Am Acad Dermatol. 2004 Mar;50(3):416-30. : Combination therapy to treat moderate to severe psoriasis.
Lebwohl M, Menter A, Koo J, Feldman SR.
In patients with moderate-to-severe psoriasis, remission can be difficult to achieve and sustain. Both acutely acting and long-term maintenance agents are needed. Speed and efficiency of available monotherapies tend to be inversely proportional to safety. Combination, rotational, and sequential approaches are often more effective and safer than single-agent therapy. Combining agents with complementary adverse effect profiles is preferable. Apparent synergistic enhancement is seen with most paired combinations of the four major therapies: acitretin, phototherapy (ultraviolet B/psoralen plus ultraviolet A), cyclosporine, and methotrexate. Of those, only cyclosporine in combination with psoralen plus ultraviolet A is contraindicated because of increased cancer risk. Combinations of each of those major therapies with topical agents (retinoids, steroids, vitamin D derivatives, and others) have been used with varying efficacy and safety. The immunomodulators, hydroxyurea and thioguanine, have also shown some success in combination therapy. The new biologic agents with their novel modes of action and adverse effect profiles may prove to be important adjuncts in combination/rotational/sequential approaches. In some cases, monotherapy (with either systemic agents or phototherapy) adequately controls moderate to severe disease. A regimen using a single agent has the advantages of lower cost and greater adherence by the patient. For any number of reasons, however, including loss of efficacy, adverse effects, or cumulative or acute toxicity-and especially the inability to clear resistant lesions-a single modality will not be adequate. Using two or more therapies is thus the rule rather than the exception for most patients with moderate-to-severe psoriasis, but picking a combination that serves to balance safety and efficacy needs careful consideration, especially since no evidence-based treatment guidelines exist.
Rev Prat. 2004 Jan 15;54(1):48-51. : [Prescription of retinoids in psoriasis]
[Article in French]
Brun P.
patrick.brun2@wanadoo.fr
Systemic retinoids inhibit keratinisation and have anti-inflammatory properties. In 30 years, they have revolutionised numerous aspects of dermatological practice, particularly in the management of psoriasis. In the management strategy of severe psoriasis, acitretin has first place of the medications currently available. It is the on-going treatment par excellence. It is even more effective and better tolerated when doses are progressively increased in steps to reach the optimal effective dose that corresponds to the maximum tolerated dose. The dose is adjusted according to this tolerance and not to standardise doses. With this precondition, the secondary effects are benign, sometimes bothersome with an increasing fragility of the mucous membranes of the epithelia and the phaneres, bearing witness to the medication impregnation of tissues and the interference with the natural retinoids. Due to their teratogenic risk, the only restriction concerns women of childbearing age in whom all prescription of retinoids is subject to some legal considerations that are indispensable to respect.
Rev Prat. 2004 Jan 15;54(1):43-7. : [Prescription of phototherapy in psoriasis]
[Article in French]
Beani JC.
Clinique de dermato-phlebologie et des maladies sexuellement transmissibles, CHU de Grenoble, BP 217X, 38043 Grenoble Cedex.
JCBeani@chu-grenoble.fr
Two types of phototherapy are used in the treatment of psoriasis. UVB phototherapy (so called TL01 excluding the most erythematogenic UVB) has acquired a position next to puvatherapy (associating co-administration of a psoralen either by oral intake or bath, with exposure to UVA) of which the efficacy has been clearly established for a long time. The use of UVB TL01 phototherapy presents less constraint but doesn't seem to be as efficient as puvatherapy in the more severe forms. The results of these two phototherapies are amplified by the addition of adjuvant treatments, in particular with the association of the oral intake of acitretin. The long-term risk of phototherapy is the induction of cutaneous cancers, essentially spinocellular carcinomas; this risk, qualified and quantified for puva, remains less clear for TL01; it imposes the need for a precise count of the number of sessions received and a prolonged follow-up of patients having received numerous phototherapy treatments. The indication for phototherapy is an extensive flare-up of psoriasis in its common form. Therapeutic rotation, during successions of flare-ups or when the phototherapy capital has been consumed, can be done with a retinoid or methotrexate, conversely it has to be much more careful with cyclosporin due to the increase of the carcinogenic risk.
Br J Dermatol. 2004 Jan;150(1):150-2. : Capillary leak syndrome induced by acitretin.
Estival JL, Dupin M, Kanitakis J, Combemale P.
Department of Dermatology, Desgenettes Military Hospital, 108 Bd Pinel, 69275 Lyon cedex 3, France.
The mucocutaneous side-effects of systemic retinoids are well known. We report a patient with diffuse oedema, which is a very rare side-effect of retinoids. The pathophysiology of this condition is poorly known because of the rarity of relevant observations, but apparently corresponds to capillary leak syndrome. The outcome is invariably favourable following withdrawal of the drug, which should be definitively contraindicated in the patient.
Successful treatment of recalcitrant psoriasis with a combination of infliximab and hydroxyurea.
Gach JE, Berth-Jones J.
Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK.
asia@jgach.freeserve.co.uk
We report the use of a combination of the tumour necrosis factor alpha (TNF alpha) inhibitor infliximab and hydroxyurea to achieve control of disabling psoriasis and psoriatic arthritis. Our patient had psoriasis that proved resistant to conventional therapy including vitamin D analogues, topical steroids, dithranol, crude coal tar, narrow band UVB, bath PUVA and acitretin. She subsequently responded to hydroxyurea 1 g daily combined with infliximab infusions repeated at three monthly intervals which led to satisfactory control of her psoriasis and psoriatic arthritis. She has not reported any side-effects from this treatment regimen and her full blood count has remained normal.
J Pharm Sci. 2003 Dec;92(12):2449-57. : Inclusion of acitretin into cyclodextrins: phase solubility, photostability, and physicochemical characterization.
Liu X, Lin HS, Thenmozhiyal JC, Chan SY, Ho PC.
Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117543.
Acitretin, a retinoid for the treatment of severe psoriasis, exhibits extremely low aqueous solubility and high photosensitivity. This study investigated the effects of the complexation of acitretin with the respective hydroxypropyl-beta-cyclodextrin (HPBCD) and randomly substituted methyl-beta-cyclodextrin (RMBCD) on the aqueous solubility and photostability of the drug. Phase-Solubility studies indicated that the solubility of acitretin was dramatically improved by formation of complexes and further increased by pH adjustment. Stability constants were much higher for acitretin complexed with RMBCD than with HPBCD. Both cyclodextrins acted to decrease degradation of acitretin in solution. The physicochemical properties of solid inclusion complexes were characterized by Fourier transform infrared spectroscopy, differential scanning calorimetry, and X-ray diffractometry. Molecular modeling with MMFF94s force field (SYBYL V6.6) was utilized to predict the preferred orientation of acitretin in the cyclodextrin cavity and the main structural features responsible for the enhancement of its solubility and photostability. Copyright 2003 Wiley-Liss, Inc.
J Cutan Med Surg. 2003 Sep-Oct;7(5):382-6. Epub 2003 Sep 24.: Use of infliximab, an anti-tumor necrosis alpha antibody, for inflammatory dermatoses.
Drosou A, Kirsner RS, Welsh E, Sullivan TP, Kerdel FA.
Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA.
BACKGROUND: Infliximab is a monoclonal antibody against tumor necrosis factor alpha currently approved by the U.S. FDA for the treatment of Crohn's disease and rheumatoid arthritis. Recently, a controlled trial reported its effectiveness for psoriasis. OBJECTIVE: The object of our study was to evaluate the efficacy and safety of infliximab for inflammatory or autoimmune cutaneous disorders. METHODS: A retrospective chart review was performed for patients who received infliximab at the University of Miami, Cedars Medical Center. RESULTS: Patients with various disease, including panniculitis, pityriasis rubra pilaris, eosinophilic fasciitis, discoid lupus erythematosus, and necrobiosis lipoidica diabeticorum, received infliximab infusion at a dose of 5 mg/kg. All patients had refractory disease or adverse effects to previous therapy, which included cyclosporine, systemic steroids, azathioprin, clofazimine, mycophenolate mofetil, acitretin, UVB, and thalidomide. Six out of the seven patients improved after treatment. CONCLUSIONS: Infliximab was well tolerated in most patients and the majority benefited from the use of infliximab.
: J Am Acad Dermatol. 2003 Aug;49(2 Suppl):S66-77. : Current systemic therapies for psoriasis: where are we now?
Yamauchi PS, Rizk D, Kormeili T, Patnaik R, Lowe NJ.
Clinical Research Specialists, UCLA School of Medicine, 2001 Santa Monica Boulevard, Santa Monica, CA 90404, USA.
Many systemic agents are used in the treatment of psoriasis. They provide good control of psoriasis in the majority of patients and have improved their life quality indices. Frequently, combination therapy is utilized to synergize the efficacy of these medications. Many dermatologists are hesitant in prescribing systemic agents because of their adverse effects. However, such potential toxicities arising from these medications can largely be avoided if proper patient selection and close monitoring are performed.
Arch Dermatol. 2003 Apr;139(4):436-42. : Comment in: Arch Dermatol. 2003 Apr;139(4):520-4.
Efficacy of acitretin and commercial tanning bed therapy for psoriasis.
Carlin CS, Callis KP, Krueger GG.
Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, 84132, USA.
krueger@derm.med.utah.edu
OBJECTIVE: To assess the efficacy of acitretin and commercial tanning bed therapy for the treatment of moderate to severe chronic plaque-type psoriasis. DESIGN: Retrospective medical record review and telephone survey of subjects and prospective open-label trial. SETTING: University dermatology clinic. PATIENTS: The study population comprised 26 subjects in the retrospective study and 17 subjects in the prospective study, all with moderate to severe plaque-type psoriasis. INTERVENTION: Twelve weeks of daily oral acitretin (25 mg) therapy and commercial tanning bed UV exposure (mean UV-B output of 4.7%) for 4 to 5 days per week. RESULTS: In the retrospective review, 19 (83%) of 23 subjects had clearance or near clearance, 2 (9%) of 23 had moderate improvement, and 2 (9%) of 23 had no improvement. Patients reported a high degree of satisfaction with the treatment. In the prospective trial, the Psoriasis Area and Severity Index (PASI) and National Psoriasis Foundation scores decreased an average of 78.6% and 79.0% from baseline, respectively. A reduction from baseline in the PASI score of 50% and 75% (PASI 50 and PASI 75) was achieved by 13 (76%) and 10 (59%) patients, respectively. Adverse events were generally mild to moderate. CONCLUSIONS: Acitretin use in combination with commercial tanning bed therapy appears to be effective and useful for psoriasis in areas without access to physician-directed phototherapy. The variability of tanning salon light and quality mandates caution when using this therapy.
Skin Therapy Lett. 2003 Apr-May;8(4):1-3, 7. : Efficacy of acitretin in severe psoriasis.
Geiger JM.
Universite Louis Pasteur, Strasbourg, France.
Acitretin (Soriatane, Roche Pharmaceuticals) is an aromatic retinoid, effective in the treatment of severe psoriasis. This study highlights data from two existing clinical trials to capture PASI 50 and PASI 75 responder rates which represent a common metric used in current psoriasis clinical trials. A review of pharmacokinetics, safety and a discussion of relapse rate establish acitretin as an efficacious, convenient, oral treatment for initial and maintenance therapy of severe psoriasis
Am J Clin Dermatol. 2003;4(7):507-10. : The efficacy of calcipotriol + acitretin combination therapy for psoriasis: comparison with acitretin monotherapy.
Rim JH, Park JY, Choe YB, Youn JI.
Department of Dermatology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
BACKGROUND: Although the use of an oral retinoid as monotherapy is an effective treatment for psoriasis, it is usually used in combination with other topical or systemic therapies including topical corticosteroids, UVB phototherapy, psoralens + UVA (PUVA) chemotherapy and cyclosporine mainly in an effort to reduce or avoid adverse effects. AIM: To compare the efficacy of the calcipotriol + acitretin combination treatment with acitretin alone over a long period in Korean patients with psoriasis. METHODS: A randomized, bilateral paired comparison was conducted involving 40 patients with psoriasis who received calcipotriol + acitretin combination therapy and 20 psoriasis patients who received acitretin alone. The initial dose of acitretin was 10 or 20 mg/day. The dose was adjusted at each visit (2, 4 and 6 weeks) in steps of 10mg according to patient responsiveness and adverse effects. The maximum dose was 40 mg/day. The treatment duration for all patients ranged from 4-52 weeks. After 12 weeks, the efficacy of therapy, according to Psoriasis Area and Severity Index scores, was assessed. At the end of the study (52 weeks), we selected patients who had achieved complete clearance and compared the duration of treatment and total dose of acitretin used in both groups. RESULTS: After 12 weeks, 16 patients (40%) achieved complete clearance in the calcipotriol + acitretin group and 3 patients (15%) in the acitretin monotherapy group (p < 0.05). After 52 weeks, 24 patients (60%) in the calcipotriol + acitretin group and 8 patients (40%) in the acitretin monotherapy group achieved complete clearance. The duration of treatment and total dose of retinoid required to achieve clearance were slightly lower in the calcipotriol + acitretin combination group, however, this was not statistically significant. With the exception of liver enzyme elevation (which affected more patients in the acitretin monotherapy group than in the combination group), adverse effects were not significantly different. DISCUSSION: Our results showed that calcipotriol might enhance the clinical outcome of systemic acitretin therapy. More large, well-controlled, long-term studies need to be conducted to determine whether there is indeed a beneficial effect of the addition of calcipotriol to acitretin treatment and whether this effect is maintained over long-term periods.
J Dermatolog Treat. 2003;14 Suppl 2:21-5. : Retrospective analysis of the treatment of psoriasis of the palms and soles.
Spuls PI, Hadi S, Rivera L, Lebwohl M.
Department of Dermatology, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029-6574, USA.
In this retrospective analysis, the effect of currently used treatments in 26 patients with psoriasis of the palms and soles were analyzed. In general, patients are treated initially with topical medications including superpotent topical corticosteroids in combination with calcipotriene ointment or tazarotene gel or both. If satisfactory improvement is not achieved in 4-8 weeks, systemic retinoids are added, formerly etretinate and currently acitretin, except in women of childbearing potential. If the latter regimen is not effective within two months, soak PUVA is added to the regimen of oral retinoids and topical medications. If improvement is inadequate, or if the treatment regimen is not tolerated, methotrexate or cyclosporine have been added in the past. The availability of the excimer laser has recently modified our approach so that this therapy is used in combination with acitretin before soak PUVA. With the availability of biologic agents, methotrexate is avoided because of its hepatotoxicity and bone marrow toxicity and cyclosporine is avoided because of its nephrotoxicity. If oral acitretin plus topical therapy is not adequate to control the disease and the excimer laser is not an option because of its limited availability, alefacept, etanercept and infliximab are added when possible. Other biologic agents are likely to be added to this list in the future.
J Dermatolog Treat. 2003;14 Suppl 2:3-6. : Acitretin suppression of squamous cell carcinoma: case report and literature review.
Lebwohl M, Tannis C, Carrasco D.
Department of Dermatology, Mount Sinai School of Medicine, 1 Gustave Levy Place, Box 1047, New York, NY 10029-6574, USA.
Retinoids have been used for the treatment and suppression of cutaneous malignancies in patients with basal cell nevus syndrome, xeroderma pigmentosum, and in patients with recurrent skin cancers as a result of immunosuppression for renal transplantation. We report a 40-year-old male who began to develop multiple squamous cell carcinomas of the skin after treatment with PUVA for severe psoriasis. The numbers of squamous cell carcinomas increased when acitretin was discontinued and decreased when he was taking the drug at a dose of 25 mg daily. Acitretin should be considered as a maintenance therapy for psoriasis patients developing squamous cell carcinomas as a result of PUVA therapy
J Eur Acad Dermatol Venereol. 2003 Jan;17(1):113-4. : Multiple cutaneous squamous carcinoma in a psoriatic associated with ciclosporin, alcohol abuse and ultraviolet radiation exposure which were suppressed by acitretin.
Agnew KL, Bunker CB.
Skin Pharmacol Appl Skin Physiol. 2003 Jan-Feb;16(1):46-9. : Peripheral sensory neuropathy associated with short-term oral acitretin therapy.
Tsambaos D, Sakkis T, Chroni E, Koniavitou K, Monastirli A, Pasmatzi E, Paschalis C.
Department of Dermatology, University of Patras, Greece.
tsambaos@med.upatras.gr
A 57-year-old female patient with widespread chronic plaque psoriasis and a 32-year-old male patient with severe oral lichen planus are reported, who developed sensory symptoms in the extremities 3 and 4 months after the onset of oral acitretin therapy, respectively. Both patients showed clinical and electrophysiological evidence of a sensory peripheral neuropathy, which completely resolved 2 and 2.5 years after discontinuation of oral acitretin administration, respectively. Copyright 2003 S. Karger AG, Basel
Ann Pharmacother. 2002 Dec;36(12):1879-82. : Acitretin-associated thrombotic stroke.
Royer B, Ziegler F, Muret P, Davani S, Kantelip JP.
Pharmacovigilance and Pharmacology Department, Jean Minjoz University Hospital, Besancon, France.
bernard.royer@ufc-chu.univ-fcomte.fr
OBJECTIVE: To report a case of thrombotic stroke. The etiology was difficult to identify, but was finally ascribed to psoriatic treatment with acitretin. CASE SUMMARY: Treatment with acitretin was prescribed for a 52-year-old white woman for long-standing psoriasis. Thirty-four days later, she developed nausea, vomiting, vertigo, and headaches, followed by left lateropulsion, which impeded standing and lying. Both neurologic examination and magnetic nuclear imaging indicated a rectangular infarct in the vermis cerebelli and a small bulbar infarct. Time-of-flight magnetic resonance angiography confirmed the presence of a thrombus at the beginning of the left vertebral artery. After heparin-based treatment and physiotherapy, the evolution was favorable. DISCUSSION: Etiology identification of the stroke included cardiogenic pathology and coagulopathy, but acitretin treatment was considered the likeliest explanation. On review of the literature, this seems to be the first case of a thrombotic event associated with acitretin. CONCLUSIONS: Acitretin should be considered as a possible cause of thrombotic stroke; this possibility should be kept in mind when patients taking acitretin develop an unexplained thrombotic event.
Clin Neuropharmacol. 2002 Nov-Dec;25(6):310-2. : Sensorimotor polyneuropathy after a three-month oral acitretin therapy.
Chroni E, Monastirli A, Pasmatzi E, Sakkis T, Georgiou S, Paschalis C, Tsambaos D.
Department of Neurology, University of Patras, Rio-Patras, Greece.
echroni@yahoo.com
We report a patient with chronic plaque psoriasis who developed clinical and electrophysiologic features of polyneuropathy affecting motor and sensory fibers in upper and lower extremities after three months of treatment with oral acitretin. Drug withdrawal resulted in a complete clinical recovery and normalization of all electrophysiologic abnormalities within two months.
Drug Saf. 2002;25(13):913-27. : Comparative tolerability of systemic treatments for plaque-type psoriasis.
McClure SL, Valentine J, Gordon KB.
Department of Dermatology, Northwestern University Medical School, Chicago, Illinois 60611, USA.
Psoriasis is a chronic, debilitating skin condition that affects millions of people and is attributed to both genetic and environmental factors. Topical therapy is generally considered to be the first-line treatment of psoriasis. However, many patients do not respond to topical therapy or have disease so extensive that topical therapy is not practical. For these patients, systemic therapy is indicated. Presently, there are four available systemic treatments, psoralen with ultraviolet A (PUVA), methotrexate, oral retinoids (acitretin), and cyclosporin. Unfortunately, all of these treatments have significant potential adverse effects. PUVA may acutely cause nausea, pruritis and sunburn. More chronic and concerning is the development of PUVA lentigines, ocular complications and skin cancer. Non-melanoma skin cancer has been directly linked to PUVA; however, the association with melonoma is more elusive. Methotrexate use most notably carries the risk of hepatic fibrosis and cirrhosis, which is not always evident on liver function tests. Other more rare, but potentially life-threatening adverse effects include pancytopenia, lymphoproliferative disorders and acute pneumonitis. The addition of folic acid may help to reduce the risk of increasing liver enzymes and haematological toxicity seen in those taking methotrexate. Both methotrexate and oral retinoids are teratogenic and should never be used in pregnancy. Oral retinoids are probably the least effective available systemic medication for the treatment of plaque psoriasis. The effects are improved with the addition of other systemic therapies. Acitretin has replaced the formerly used etretinate primarily because of the significantly shorter half-life. The adverse effects are generally mild and reversible, making the drug fairly safe for long-term use. The most commonly seen adverse effects include elevated serum lipids, generalised xerosis and alopecia. Bony abnormalities, while somewhat controversial, have also been described and include diffuse idiopathic skeletal hyperostosis, skeletal calcifications and osteoporosis. Cyclosporin is the most recently approved systemic medication for plaque psoriasis. The nephrotoxicity associated with the use of cyclosporin can be minimised when used in lower doses and for a limited duration. Hypertension is usually mild and can be seen in up to about one-third of patients receiving long-term therapy. Cutaneous and internal malignancies have also been reported with cyclosporin and tend to be correlated with duration of treatment. In this review, we will examine the potential adverse effects with these US Food and Drug Administration-approved treatments in adults, with specific emphasis on the controversies that surround long-term therapy with these agents and their cumulative adverse effects.
.
Soritane, aromatic retinoid, comes in a gelatin pill form treatment for Psoriasis. The active ingredient in Soriatane is related to Vitamin A so you are warned about taking supplements. Bothwomen and indirectly men are warned about pregnancy for up to three years after taking Soriatane. There are also warnings as to alcohol intake. There are also warnings about possible depression, dry eyes and chapped lips.
The skin grows usually every 28 days or so whereas in psoriasis, it grows every three to six days and forms plaques or lesions.
. Psoriasis is often called an "immune-mediated" disorder where the immune system attacks itself. Close to five million people in the U.S. suffer from Psoriasis. Studies show there is a genetic component but as of yet don't know what triggers the outbreaks. Some say to avoid acidic food, alcohol, root vegetables and coffee but there is no firm research to back that up. Possible triggers for psoriasis are emotional stress, reactions to certain drugs such as lithium, ace inhibitors, and beta blockers. Changes in weather may be a trigger for psoriasis. Then there are skin trauma, and infection. .An indepth article can be found here
.
Curr Drug Targets Inflamm Allergy. 2004 Jun;3(2):199-204. : New vitamin d analogs in psoriasis.
Fogh K, Kragballe K.
Department of Dermatology, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark.
SEK12JNI@aas.auh.dk
Psoriasis is a common inflammatory and hyperproleferative skin disease characterized by infiltrated plaques of the skin and may involve nails, scalp and intertreginous areas. Recent years of research has shown that psoriasis can be treated topically with analogs of vitamin-D(3). Impaired differentiation and increased proliferation of epidermal keratinocytes are key features in psoriatic lesions together with a local activation of T lymphocytes. Evidence has accumulated that analogs of vitamin D(3) increase differentiation and inhibit proliferation of keratinocytes. Topical treatment with analogs of vitamin D(3) have in a number of trials shown improvement of psoriasis. Vitamin D analogs show the same efficacy as potent topical corticosteroids and do not produce skin atrophy during long-term therapy. Vitamin D analogs can be used both as monotherapy and in combination with topical corticosteroids, UVB, PUVA, acitretin, methotrexate and cyclosporine. The vitamin D(3) analog calcipotriol has been investigated in most detail and is available as an ointment, a cream and as a scalp solution. From clinical studies involving several thousands of patients, it can be concluded that calcipotriol is efficacious, safe and well-tolerated even on a long term basis
Curr Drug Targets Inflamm Allergy. 2004 Jun;3(2):145-56. : Established treatments of psoriasis.
Van De Kerkhof PC, Vissers WH.
Department of Dermatology, University Medical Centre St. Radboud, Nijmegen, The Netherlands.
p.vandekerkhof@derma.umcn.nl
Psoriasis is a complex disease with a spectrum of clinical manifestations. Psoriasis may express as a few coin-sized erythemato-squamous plaques up to widespread disease covering the entire body surface (erythrodermic psoriasis). Psoriasis may present as a few stable plaques or unstable disease, rapidly relapsing after treatment. Some patients may respond excellently to topical treatments whereas other patients may be difficult to manage, showing treatment resistance even to the systemic treatments. Therefore, a spectrum of treatments is available to individualize care of psoriasis. In this chapter the available treatments are presented. The vast majority of patients is treated with topical treatments, with vitamin D(3)analogs and topical corticosteroids as the first line treatments. Tazarotene is an alternative for vitamin D(3) treatment if this treatment fails. In some special cases, dithranol and tar treatment may be used. Phototherapy with UVB and photochemotherapy (PUVA) are indicated in patients not responding sufficiently to topical treatment. However, chronic exposure, in particular to photochemotherapy implies an increased risk for photo- carcinogenicity. Systemic treatments including methotrexate, cyclosporin, acitretin and fumarates are indicated in patients who cannot be managed with topical treatments or phototherapy, either for treatment resistance or cumulative toxicity. In this article the opportunities and limitations of the available treatments are presented.
: Br J Dermatol. 2004 Apr;150(4):741-6.: Fumaric acid esters in severe psoriasis, including experience of use in combination with other systemic modalities.
Balasubramaniam P, Stevenson O, Berth-Jones J.
George Eliot Hospital, Nuneaton CV10 7DJ and Walsgrave Hospital, Coventry CV2 2DX, UK.
BACKGROUND: Fumaric acid esters (FAE) are used as a systemic treatment for severe psoriasis in Germany but there has been only very little published experience from the U.K. The potential for use in combination with other systemic drugs has not been explored. OBJECTIVES: To present data relating to the efficacy of FAE in severe psoriasis and to examine the potential dose-sparing effect and safety issues when FAE are combined with other systemic agents. METHODS: We retrospectively analysed the records of patients who had received FAE for severe psoriasis either alone (in two cases) or along with other systemic medications (in 10 cases). We reviewed the efficacy of FAE and assessed whether dose reductions were achieved for other systemic drugs. Patients were monitored carefully for possible adverse effects. RESULTS: Of 12 patients treated with FAE one discontinued the drug very early, due to flushing, while on a very low dose. The other 11 patients all demonstrated an improvement in psoriasis after starting FAE. Nine patients received FAE in combination with other systemic therapies including ciclosporin, acitretin, hydroxyurea and methotrexate. Seven achieved useful overall reductions in the dose of the other drugs. In two patients severe psoriasis was controlled using FAE alone. The side-effect profile of FAE was similar to that previously reported. There was no evidence of drug interactions. CONCLUSIONS: FAE appear effective and less toxic than other systemic treatments for psoriasis. FAE were used successfully in combination with other systemic agents and generally enabled the doses of the more hazardous drugs to be reduced. Extremely careful monitoring is required when using FAE in such combined regimens as experience is currently very limited.
J Am Acad Dermatol. 2004 Mar;50(3):416-30. : Combination therapy to treat moderate to severe psoriasis.
Lebwohl M, Menter A, Koo J, Feldman SR.
In patients with moderate-to-severe psoriasis, remission can be difficult to achieve and sustain. Both acutely acting and long-term maintenance agents are needed. Speed and efficiency of available monotherapies tend to be inversely proportional to safety. Combination, rotational, and sequential approaches are often more effective and safer than single-agent therapy. Combining agents with complementary adverse effect profiles is preferable. Apparent synergistic enhancement is seen with most paired combinations of the four major therapies: acitretin, phototherapy (ultraviolet B/psoralen plus ultraviolet A), cyclosporine, and methotrexate. Of those, only cyclosporine in combination with psoralen plus ultraviolet A is contraindicated because of increased cancer risk. Combinations of each of those major therapies with topical agents (retinoids, steroids, vitamin D derivatives, and others) have been used with varying efficacy and safety. The immunomodulators, hydroxyurea and thioguanine, have also shown some success in combination therapy. The new biologic agents with their novel modes of action and adverse effect profiles may prove to be important adjuncts in combination/rotational/sequential approaches. In some cases, monotherapy (with either systemic agents or phototherapy) adequately controls moderate to severe disease. A regimen using a single agent has the advantages of lower cost and greater adherence by the patient. For any number of reasons, however, including loss of efficacy, adverse effects, or cumulative or acute toxicity-and especially the inability to clear resistant lesions-a single modality will not be adequate. Using two or more therapies is thus the rule rather than the exception for most patients with moderate-to-severe psoriasis, but picking a combination that serves to balance safety and efficacy needs careful consideration, especially since no evidence-based treatment guidelines exist.
Rev Prat. 2004 Jan 15;54(1):48-51. : [Prescription of retinoids in psoriasis]
[Article in French]
Brun P.
patrick.brun2@wanadoo.fr
Systemic retinoids inhibit keratinisation and have anti-inflammatory properties. In 30 years, they have revolutionised numerous aspects of dermatological practice, particularly in the management of psoriasis. In the management strategy of severe psoriasis, acitretin has first place of the medications currently available. It is the on-going treatment par excellence. It is even more effective and better tolerated when doses are progressively increased in steps to reach the optimal effective dose that corresponds to the maximum tolerated dose. The dose is adjusted according to this tolerance and not to standardise doses. With this precondition, the secondary effects are benign, sometimes bothersome with an increasing fragility of the mucous membranes of the epithelia and the phaneres, bearing witness to the medication impregnation of tissues and the interference with the natural retinoids. Due to their teratogenic risk, the only restriction concerns women of childbearing age in whom all prescription of retinoids is subject to some legal considerations that are indispensable to respect.
Rev Prat. 2004 Jan 15;54(1):43-7. : [Prescription of phototherapy in psoriasis]
[Article in French]
Beani JC.
Clinique de dermato-phlebologie et des maladies sexuellement transmissibles, CHU de Grenoble, BP 217X, 38043 Grenoble Cedex.
JCBeani@chu-grenoble.fr
Two types of phototherapy are used in the treatment of psoriasis. UVB phototherapy (so called TL01 excluding the most erythematogenic UVB) has acquired a position next to puvatherapy (associating co-administration of a psoralen either by oral intake or bath, with exposure to UVA) of which the efficacy has been clearly established for a long time. The use of UVB TL01 phototherapy presents less constraint but doesn't seem to be as efficient as puvatherapy in the more severe forms. The results of these two phototherapies are amplified by the addition of adjuvant treatments, in particular with the association of the oral intake of acitretin. The long-term risk of phototherapy is the induction of cutaneous cancers, essentially spinocellular carcinomas; this risk, qualified and quantified for puva, remains less clear for TL01; it imposes the need for a precise count of the number of sessions received and a prolonged follow-up of patients having received numerous phototherapy treatments. The indication for phototherapy is an extensive flare-up of psoriasis in its common form. Therapeutic rotation, during successions of flare-ups or when the phototherapy capital has been consumed, can be done with a retinoid or methotrexate, conversely it has to be much more careful with cyclosporin due to the increase of the carcinogenic risk.
Br J Dermatol. 2004 Jan;150(1):150-2. : Capillary leak syndrome induced by acitretin.
Estival JL, Dupin M, Kanitakis J, Combemale P.
Department of Dermatology, Desgenettes Military Hospital, 108 Bd Pinel, 69275 Lyon cedex 3, France.
The mucocutaneous side-effects of systemic retinoids are well known. We report a patient with diffuse oedema, which is a very rare side-effect of retinoids. The pathophysiology of this condition is poorly known because of the rarity of relevant observations, but apparently corresponds to capillary leak syndrome. The outcome is invariably favourable following withdrawal of the drug, which should be definitively contraindicated in the patient.
Successful treatment of recalcitrant psoriasis with a combination of infliximab and hydroxyurea.
Gach JE, Berth-Jones J.
Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK.
asia@jgach.freeserve.co.uk
We report the use of a combination of the tumour necrosis factor alpha (TNF alpha) inhibitor infliximab and hydroxyurea to achieve control of disabling psoriasis and psoriatic arthritis. Our patient had psoriasis that proved resistant to conventional therapy including vitamin D analogues, topical steroids, dithranol, crude coal tar, narrow band UVB, bath PUVA and acitretin. She subsequently responded to hydroxyurea 1 g daily combined with infliximab infusions repeated at three monthly intervals which led to satisfactory control of her psoriasis and psoriatic arthritis. She has not reported any side-effects from this treatment regimen and her full blood count has remained normal.
J Pharm Sci. 2003 Dec;92(12):2449-57. : Inclusion of acitretin into cyclodextrins: phase solubility, photostability, and physicochemical characterization.
Liu X, Lin HS, Thenmozhiyal JC, Chan SY, Ho PC.
Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117543.
Acitretin, a retinoid for the treatment of severe psoriasis, exhibits extremely low aqueous solubility and high photosensitivity. This study investigated the effects of the complexation of acitretin with the respective hydroxypropyl-beta-cyclodextrin (HPBCD) and randomly substituted methyl-beta-cyclodextrin (RMBCD) on the aqueous solubility and photostability of the drug. Phase-Solubility studies indicated that the solubility of acitretin was dramatically improved by formation of complexes and further increased by pH adjustment. Stability constants were much higher for acitretin complexed with RMBCD than with HPBCD. Both cyclodextrins acted to decrease degradation of acitretin in solution. The physicochemical properties of solid inclusion complexes were characterized by Fourier transform infrared spectroscopy, differential scanning calorimetry, and X-ray diffractometry. Molecular modeling with MMFF94s force field (SYBYL V6.6) was utilized to predict the preferred orientation of acitretin in the cyclodextrin cavity and the main structural features responsible for the enhancement of its solubility and photostability. Copyright 2003 Wiley-Liss, Inc.
J Cutan Med Surg. 2003 Sep-Oct;7(5):382-6. Epub 2003 Sep 24.: Use of infliximab, an anti-tumor necrosis alpha antibody, for inflammatory dermatoses.
Drosou A, Kirsner RS, Welsh E, Sullivan TP, Kerdel FA.
Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA.
BACKGROUND: Infliximab is a monoclonal antibody against tumor necrosis factor alpha currently approved by the U.S. FDA for the treatment of Crohn's disease and rheumatoid arthritis. Recently, a controlled trial reported its effectiveness for psoriasis. OBJECTIVE: The object of our study was to evaluate the efficacy and safety of infliximab for inflammatory or autoimmune cutaneous disorders. METHODS: A retrospective chart review was performed for patients who received infliximab at the University of Miami, Cedars Medical Center. RESULTS: Patients with various disease, including panniculitis, pityriasis rubra pilaris, eosinophilic fasciitis, discoid lupus erythematosus, and necrobiosis lipoidica diabeticorum, received infliximab infusion at a dose of 5 mg/kg. All patients had refractory disease or adverse effects to previous therapy, which included cyclosporine, systemic steroids, azathioprin, clofazimine, mycophenolate mofetil, acitretin, UVB, and thalidomide. Six out of the seven patients improved after treatment. CONCLUSIONS: Infliximab was well tolerated in most patients and the majority benefited from the use of infliximab.
: J Am Acad Dermatol. 2003 Aug;49(2 Suppl):S66-77. : Current systemic therapies for psoriasis: where are we now?
Yamauchi PS, Rizk D, Kormeili T, Patnaik R, Lowe NJ.
Clinical Research Specialists, UCLA School of Medicine, 2001 Santa Monica Boulevard, Santa Monica, CA 90404, USA.
Many systemic agents are used in the treatment of psoriasis. They provide good control of psoriasis in the majority of patients and have improved their life quality indices. Frequently, combination therapy is utilized to synergize the efficacy of these medications. Many dermatologists are hesitant in prescribing systemic agents because of their adverse effects. However, such potential toxicities arising from these medications can largely be avoided if proper patient selection and close monitoring are performed.
Arch Dermatol. 2003 Apr;139(4):436-42. : Comment in: Arch Dermatol. 2003 Apr;139(4):520-4.
Efficacy of acitretin and commercial tanning bed therapy for psoriasis.
Carlin CS, Callis KP, Krueger GG.
Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, 84132, USA.
krueger@derm.med.utah.edu
OBJECTIVE: To assess the efficacy of acitretin and commercial tanning bed therapy for the treatment of moderate to severe chronic plaque-type psoriasis. DESIGN: Retrospective medical record review and telephone survey of subjects and prospective open-label trial. SETTING: University dermatology clinic. PATIENTS: The study population comprised 26 subjects in the retrospective study and 17 subjects in the prospective study, all with moderate to severe plaque-type psoriasis. INTERVENTION: Twelve weeks of daily oral acitretin (25 mg) therapy and commercial tanning bed UV exposure (mean UV-B output of 4.7%) for 4 to 5 days per week. RESULTS: In the retrospective review, 19 (83%) of 23 subjects had clearance or near clearance, 2 (9%) of 23 had moderate improvement, and 2 (9%) of 23 had no improvement. Patients reported a high degree of satisfaction with the treatment. In the prospective trial, the Psoriasis Area and Severity Index (PASI) and National Psoriasis Foundation scores decreased an average of 78.6% and 79.0% from baseline, respectively. A reduction from baseline in the PASI score of 50% and 75% (PASI 50 and PASI 75) was achieved by 13 (76%) and 10 (59%) patients, respectively. Adverse events were generally mild to moderate. CONCLUSIONS: Acitretin use in combination with commercial tanning bed therapy appears to be effective and useful for psoriasis in areas without access to physician-directed phototherapy. The variability of tanning salon light and quality mandates caution when using this therapy.
Skin Therapy Lett. 2003 Apr-May;8(4):1-3, 7. : Efficacy of acitretin in severe psoriasis.
Geiger JM.
Universite Louis Pasteur, Strasbourg, France.
Acitretin (Soriatane, Roche Pharmaceuticals) is an aromatic retinoid, effective in the treatment of severe psoriasis. This study highlights data from two existing clinical trials to capture PASI 50 and PASI 75 responder rates which represent a common metric used in current psoriasis clinical trials. A review of pharmacokinetics, safety and a discussion of relapse rate establish acitretin as an efficacious, convenient, oral treatment for initial and maintenance therapy of severe psoriasis
Am J Clin Dermatol. 2003;4(7):507-10. : The efficacy of calcipotriol + acitretin combination therapy for psoriasis: comparison with acitretin monotherapy.
Rim JH, Park JY, Choe YB, Youn JI.
Department of Dermatology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
BACKGROUND: Although the use of an oral retinoid as monotherapy is an effective treatment for psoriasis, it is usually used in combination with other topical or systemic therapies including topical corticosteroids, UVB phototherapy, psoralens + UVA (PUVA) chemotherapy and cyclosporine mainly in an effort to reduce or avoid adverse effects. AIM: To compare the efficacy of the calcipotriol + acitretin combination treatment with acitretin alone over a long period in Korean patients with psoriasis. METHODS: A randomized, bilateral paired comparison was conducted involving 40 patients with psoriasis who received calcipotriol + acitretin combination therapy and 20 psoriasis patients who received acitretin alone. The initial dose of acitretin was 10 or 20 mg/day. The dose was adjusted at each visit (2, 4 and 6 weeks) in steps of 10mg according to patient responsiveness and adverse effects. The maximum dose was 40 mg/day. The treatment duration for all patients ranged from 4-52 weeks. After 12 weeks, the efficacy of therapy, according to Psoriasis Area and Severity Index scores, was assessed. At the end of the study (52 weeks), we selected patients who had achieved complete clearance and compared the duration of treatment and total dose of acitretin used in both groups. RESULTS: After 12 weeks, 16 patients (40%) achieved complete clearance in the calcipotriol + acitretin group and 3 patients (15%) in the acitretin monotherapy group (p < 0.05). After 52 weeks, 24 patients (60%) in the calcipotriol + acitretin group and 8 patients (40%) in the acitretin monotherapy group achieved complete clearance. The duration of treatment and total dose of retinoid required to achieve clearance were slightly lower in the calcipotriol + acitretin combination group, however, this was not statistically significant. With the exception of liver enzyme elevation (which affected more patients in the acitretin monotherapy group than in the combination group), adverse effects were not significantly different. DISCUSSION: Our results showed that calcipotriol might enhance the clinical outcome of systemic acitretin therapy. More large, well-controlled, long-term studies need to be conducted to determine whether there is indeed a beneficial effect of the addition of calcipotriol to acitretin treatment and whether this effect is maintained over long-term periods.
J Dermatolog Treat. 2003;14 Suppl 2:21-5. : Retrospective analysis of the treatment of psoriasis of the palms and soles.
Spuls PI, Hadi S, Rivera L, Lebwohl M.
Department of Dermatology, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029-6574, USA.
In this retrospective analysis, the effect of currently used treatments in 26 patients with psoriasis of the palms and soles were analyzed. In general, patients are treated initially with topical medications including superpotent topical corticosteroids in combination with calcipotriene ointment or tazarotene gel or both. If satisfactory improvement is not achieved in 4-8 weeks, systemic retinoids are added, formerly etretinate and currently acitretin, except in women of childbearing potential. If the latter regimen is not effective within two months, soak PUVA is added to the regimen of oral retinoids and topical medications. If improvement is inadequate, or if the treatment regimen is not tolerated, methotrexate or cyclosporine have been added in the past. The availability of the excimer laser has recently modified our approach so that this therapy is used in combination with acitretin before soak PUVA. With the availability of biologic agents, methotrexate is avoided because of its hepatotoxicity and bone marrow toxicity and cyclosporine is avoided because of its nephrotoxicity. If oral acitretin plus topical therapy is not adequate to control the disease and the excimer laser is not an option because of its limited availability, alefacept, etanercept and infliximab are added when possible. Other biologic agents are likely to be added to this list in the future.
J Dermatolog Treat. 2003;14 Suppl 2:3-6. : Acitretin suppression of squamous cell carcinoma: case report and literature review.
Lebwohl M, Tannis C, Carrasco D.
Department of Dermatology, Mount Sinai School of Medicine, 1 Gustave Levy Place, Box 1047, New York, NY 10029-6574, USA.
Retinoids have been used for the treatment and suppression of cutaneous malignancies in patients with basal cell nevus syndrome, xeroderma pigmentosum, and in patients with recurrent skin cancers as a result of immunosuppression for renal transplantation. We report a 40-year-old male who began to develop multiple squamous cell carcinomas of the skin after treatment with PUVA for severe psoriasis. The numbers of squamous cell carcinomas increased when acitretin was discontinued and decreased when he was taking the drug at a dose of 25 mg daily. Acitretin should be considered as a maintenance therapy for psoriasis patients developing squamous cell carcinomas as a result of PUVA therapy
J Eur Acad Dermatol Venereol. 2003 Jan;17(1):113-4. : Multiple cutaneous squamous carcinoma in a psoriatic associated with ciclosporin, alcohol abuse and ultraviolet radiation exposure which were suppressed by acitretin.
Agnew KL, Bunker CB.
Skin Pharmacol Appl Skin Physiol. 2003 Jan-Feb;16(1):46-9. : Peripheral sensory neuropathy associated with short-term oral acitretin therapy.
Tsambaos D, Sakkis T, Chroni E, Koniavitou K, Monastirli A, Pasmatzi E, Paschalis C.
Department of Dermatology, University of Patras, Greece.
tsambaos@med.upatras.gr
A 57-year-old female patient with widespread chronic plaque psoriasis and a 32-year-old male patient with severe oral lichen planus are reported, who developed sensory symptoms in the extremities 3 and 4 months after the onset of oral acitretin therapy, respectively. Both patients showed clinical and electrophysiological evidence of a sensory peripheral neuropathy, which completely resolved 2 and 2.5 years after discontinuation of oral acitretin administration, respectively. Copyright 2003 S. Karger AG, Basel
Ann Pharmacother. 2002 Dec;36(12):1879-82. : Acitretin-associated thrombotic stroke.
Royer B, Ziegler F, Muret P, Davani S, Kantelip JP.
Pharmacovigilance and Pharmacology Department, Jean Minjoz University Hospital, Besancon, France.
bernard.royer@ufc-chu.univ-fcomte.fr
OBJECTIVE: To report a case of thrombotic stroke. The etiology was difficult to identify, but was finally ascribed to psoriatic treatment with acitretin. CASE SUMMARY: Treatment with acitretin was prescribed for a 52-year-old white woman for long-standing psoriasis. Thirty-four days later, she developed nausea, vomiting, vertigo, and headaches, followed by left lateropulsion, which impeded standing and lying. Both neurologic examination and magnetic nuclear imaging indicated a rectangular infarct in the vermis cerebelli and a small bulbar infarct. Time-of-flight magnetic resonance angiography confirmed the presence of a thrombus at the beginning of the left vertebral artery. After heparin-based treatment and physiotherapy, the evolution was favorable. DISCUSSION: Etiology identification of the stroke included cardiogenic pathology and coagulopathy, but acitretin treatment was considered the likeliest explanation. On review of the literature, this seems to be the first case of a thrombotic event associated with acitretin. CONCLUSIONS: Acitretin should be considered as a possible cause of thrombotic stroke; this possibility should be kept in mind when patients taking acitretin develop an unexplained thrombotic event.
Clin Neuropharmacol. 2002 Nov-Dec;25(6):310-2. : Sensorimotor polyneuropathy after a three-month oral acitretin therapy.
Chroni E, Monastirli A, Pasmatzi E, Sakkis T, Georgiou S, Paschalis C, Tsambaos D.
Department of Neurology, University of Patras, Rio-Patras, Greece.
echroni@yahoo.com
We report a patient with chronic plaque psoriasis who developed clinical and electrophysiologic features of polyneuropathy affecting motor and sensory fibers in upper and lower extremities after three months of treatment with oral acitretin. Drug withdrawal resulted in a complete clinical recovery and normalization of all electrophysiologic abnormalities within two months.
Drug Saf. 2002;25(13):913-27. : Comparative tolerability of systemic treatments for plaque-type psoriasis.
McClure SL, Valentine J, Gordon KB.
Department of Dermatology, Northwestern University Medical School, Chicago, Illinois 60611, USA.
Psoriasis is a chronic, debilitating skin condition that affects millions of people and is attributed to both genetic and environmental factors. Topical therapy is generally considered to be the first-line treatment of psoriasis. However, many patients do not respond to topical therapy or have disease so extensive that topical therapy is not practical. For these patients, systemic therapy is indicated. Presently, there are four available systemic treatments, psoralen with ultraviolet A (PUVA), methotrexate, oral retinoids (acitretin), and cyclosporin. Unfortunately, all of these treatments have significant potential adverse effects. PUVA may acutely cause nausea, pruritis and sunburn. More chronic and concerning is the development of PUVA lentigines, ocular complications and skin cancer. Non-melanoma skin cancer has been directly linked to PUVA; however, the association with melonoma is more elusive. Methotrexate use most notably carries the risk of hepatic fibrosis and cirrhosis, which is not always evident on liver function tests. Other more rare, but potentially life-threatening adverse effects include pancytopenia, lymphoproliferative disorders and acute pneumonitis. The addition of folic acid may help to reduce the risk of increasing liver enzymes and haematological toxicity seen in those taking methotrexate. Both methotrexate and oral retinoids are teratogenic and should never be used in pregnancy. Oral retinoids are probably the least effective available systemic medication for the treatment of plaque psoriasis. The effects are improved with the addition of other systemic therapies. Acitretin has replaced the formerly used etretinate primarily because of the significantly shorter half-life. The adverse effects are generally mild and reversible, making the drug fairly safe for long-term use. The most commonly seen adverse effects include elevated serum lipids, generalised xerosis and alopecia. Bony abnormalities, while somewhat controversial, have also been described and include diffuse idiopathic skeletal hyperostosis, skeletal calcifications and osteoporosis. Cyclosporin is the most recently approved systemic medication for plaque psoriasis. The nephrotoxicity associated with the use of cyclosporin can be minimised when used in lower doses and for a limited duration. Hypertension is usually mild and can be seen in up to about one-third of patients receiving long-term therapy. Cutaneous and internal malignancies have also been reported with cyclosporin and tend to be correlated with duration of treatment. In this review, we will examine the potential adverse effects with these US Food and Drug Administration-approved treatments in adults, with specific emphasis on the controversies that surround long-term therapy with these agents and their cumulative adverse effects.
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